Dual isotope SPECT imaging in the detection of coronary artery vasculopathy after heart transplant, a prospective study in 96 heart recipients.

With a survival rate of 70% at 3 years, cardiac transplantation is the best treatment for end-stage heart disease. However, progressive development of graft atherosclerosis is frequent.: Diagnosis of transplant coronary disea se remains difficult and non-invasive tests have-proved relatively insensit ive. Therefore, coronary angiography performed annually is still the gold-s tandard test for the detection of heart transplant vasculopathy. We analyzed the records of 96 patients (82 men and 14 women) who were trans planted from 1986 to 1996. Mean age was 53 +/- 2.7 and time elapsed from tr ansplantation was mean 5.3 +/- 10 years. All patients had rest myocardial T 1 201 perfusion SPECT, followed by MIBI gated SPECT after exercise. MIBI ga ted SPECT allows simultaneous evaluation of perfusion, regional LV function and global ejection fraction. Angiocoronarography, performed in all patien ts during the six months following radionuclide investigation,: showed the presence of coronary heart vasculopathy in nine (9.3%). Seven of these pati ents had abnormal dual isotope imaging and 2 of them had normal perfusion b ut altered LV regional function. Sensitivity of dual isotope scintigraphy w as 77% and specificity was 97.7%. Dual isotope scintigraphy is helpful to detect coronary vasculopathy in hea rt transplant recipients and may reduce indications of angiocoronarography.